Primary care in rural areas: a qualitative study on medical students' images and experiences of working in rural areas in southern Germany

Background: Rural areas are increasingly moving back into the focus of social research, especially in the context of health care. As the shortage of general practitioners (GP) in rural areas is a significant challenge in Germany, there are several programs to counteract underuse effectively, acutely, and sustainably. One of those programs is 'Beste Landpartie Allgemeinmedizin' (BeLA), which was developed to strengthen primary care in rural areas and to sustainably promote young doctors to work as general practitioners in rural regions through didactical and financial support. The program includes an accompanying qualitative study exploring the motivational structures of medical students from a sociological perspective. For this study, the nexus of working in rural areas from the perspective of medical students with different forms of rural experiences was of interest.

Methods: Qualitative interviews have been conducted at regular intervals on an ongoing basis since 2020 to investigate motivational retention effects during the program. The current 33 interviews were analysed using the sociological conceptual framework of spatial methods.

Results: The images and experiences of working in rural areas condition medical education in various ways. In addition to general images of living and working in rural areas in a biographical dimension, the idea of working as a GP in rural areas includes images of specific medical competencies and is conditioned by different medical tasks. From such a perspective, the images and attributions of working in primary care in a rural region demonstrate particularities, challenges, and the potential attractiveness of working in rural regions.

Discussion: The images and experiences of rural areas condition medical education in various ways and shape the expectations and the decision-making of possibly working in rural areas. The particularities, opportunities, and challenges of working in rural areas, which relate to both professional aspects and social life, are a major factor in the attractiveness of a potential rural practice. Didactical and educational curricula need to adapt the various attributions of working in rural areas.